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APPLICATIOr�r FOR CONSTRUCT�.IN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, Wq g8201 • 259-8810 <br /> ❑ DEMOLITION �I COMBINATION f-1 BUILDING I� MECHANICAL f� PLUMBING i-1 SIGN <br /> PROJECT ADDRESS �� 2D i"7 �� I <br /> J (� <br /> OWNER MAILADURE55 <br /> ��L�RSZ ClC't�.� � zir <br /> � ��`�O (�, riwNe <br /> MAILADDPE55 C \ �'1���' 1�' �,g 2�3 <br /> CITY ZIP PMONE <br /> ARCHR[CTORDE KER MAILAODRE55 � ' < < � <br /> .SQ_�� an zir �.7 �� � <br /> PHONC <br /> NIIiqCTOR MAILAD�RESS <br /> CITV ZIP PNONE <br /> S7ATE LICENSE� <br /> MECHIINICAL ONiRqCTOR MAILADDRE55 <br /> CITY ZIP PIIONG <br /> STAtE LICENSE� <br /> PLUMBINGC N qCTOR Ma1LADDRE55 <br /> CITV ZIP PIiONE <br /> STATE IIGENSE• <br /> CONTRqCTPRICEOF ORK <br /> ���-C�0.�S=�10 000,Oo �}� HEATING SYSTEM: '`�GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK AN SOUARE FOOTAGE INVOLVEO <br /> 1 GONTACi PERSON AND PHONE NO. <br /> \ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPpSED USE OF BIIILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � �(`('� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �E �oesc I TIONOFPqOPERTY� �owNee IORATTACNTWOCOPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi B��K oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> — AUTHORITY TO VIOLqTE OR CANCEL THE PROVISION OF ANY <br /> ,St. 7 OTHEH STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOf11ZED BY THE <br /> A PN CATOIONHI SP MqDETAND PERCOMP YHEVWORKT ER STATE <br /> PARCEL TAX I.O.NUh18ER CONTRACTORS LAW 1027 RCW AND 296200 WAC, <br /> �0.-�(r -Oca'�- 02a' 7n0� <br /> CONSTqUCT10NLOANIENDER.FU�RE55.TELEPNORENUMBER �^ <br /> �Ssah�.� C�� �. � 5-�5-g� <br /> DATE <br /> CITV BUSINE55 UCENSE N0. <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM MECHANICAL <br /> FEE N0. TYPE OF FIXTURE OR ITEM FEE <br /> WATER CLOSET(TOILET) / <br /> ' A/C—AMNDLGUNITS—H.P. <br /> BATHTUB � � <br /> LAVATORY(WqSH BASIN) � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � HEAT PUMP ' <br /> SHOWER � <br /> KITCHEN SINK&DISP UNIT HEATERS—B.T.U. M i <br /> DISHWqSHER ' CLOTHESDRYERS � <br /> ' ' VENTILATION FAN � <br /> LAUNDRY TRAY � <br /> CLOTHES WASHER � RANGE HOOD � <br /> URINAL ' WATER HEATER � <br /> DRINKING FOUNTAIN � WOOD STOVE , � <br /> FLOOR DRAIN ' MET�L FIREPLACE(WOOD BURNING) ' <br /> i <br /> FIREPLACE INSERT(WOOD BURNING) i <br /> BACKFLOW PREVENTERS � <br /> SINN(SERVICE—BAR.ETC.) ' GAS FIREPLACE , <br /> ' GAS RANGE � <br /> ' GAS PIPING , <br /> � EXHAUSTFAN <br /> � � � <br /> � <br /> J✓ , � <br /> � <br /> i _T_ <br /> SUB TOTAL ' <br /> S ' SUB TOTAL S � <br /> PERMIT , PERMIT <br /> TOTALFEE g � , g � <br /> TOTAL FEE S -� � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB qEAq SET04GR <br /> � SIOE SETBAC <br /> `� / PLAN CNECK N({J�,�I0 R FEE/ � RECEIPT NO. � l <br /> USEZONE � LOTAREA � � L/" � / �L • �'� I/� �fV <br /> p _ . � � �C Vr1CANi51iE FEES VALUATION <br /> —__�_� nves r FEE <br /> HEIGNTLIMITATION � OUILDING /,7�I.�� / ;�'` <br /> NOOPDWEWNG 512EOFBL�G?I. (/ jl <br /> UNIiS <br /> PLl/MOING � � <br /> i <br /> GCCU�ANCY NOOFSi0RIE5 p��UPFNT AO BASEMENT � <br /> • � � / �]1 L MECHANICAL I <br /> � �5 fl NO � � <br /> FIqEALAqMqEO'D REASON AUOIT70NALPLANLHECK ' � <br /> i <br /> i <br /> FIRE SPRINKLER REO'D REASON � O7HER � <br /> ST O�• ST�TE DUILDING SURCH4qGE � � <br /> TYPE OF CONST PLpNS AP�py � <br /> CITY OF EVERETT ruoucwonres � <br /> LOCALSALES I <br /> DATE j TAX CODE IS 3105 TOTAL � <br /> i <br />